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Unplanned Return to the Operating Room After Keratoplasty
Faiqa Binte Aamir1, Malik Muhammad Hamza Khan2, Muhammad Jehanzeb Khan1
1The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD; and.
Cornea
|June 8, 2026
Summary
Seven percent of patients required an unplanned return to the operating room (OR) within 90 days after keratoplasty. Graft detachment was the most common reason, with Deep Anterior Lamellar Keratoplasty (DALK) having the highest return rate.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Surgical Outcomes
Background:
- Corneal transplantation, or keratoplasty, restores vision but can necessitate further surgical intervention.
- Unplanned returns to the operating room (OR) after keratoplasty impact patient outcomes and healthcare resources.
- Understanding the incidence and causes of these returns is crucial for improving surgical quality.
Purpose of the Study:
- To determine the incidence of unplanned returns to the OR within 90 days following various types of keratoplasty.
- To identify risk factors associated with these returns.
- To ascertain the primary indications for reoperation after corneal transplantation.
Main Methods:
- A retrospective cohort study analyzed 984 keratoplasty procedures (DSEK, DMEK, DALK, PK) performed between 2019 and 2022.
- Rates of unplanned return to the OR were calculated, along with temporal trends.
- Multivariable logistic regression identified factors associated with reoperations.
Main Results:
- Overall, 7% (69/984) of patients returned to the OR within 90 days.
- Deep Anterior Lamellar Keratoplasty (DALK) had the highest return rate (22.5%), followed by Descemet Stripping Endothelial Keratoplasty (DSEK) (11.7%).
- Graft detachment was the most frequent indication for reoperation, with most occurring within 30 days post-keratoplasty.
Conclusions:
- The incidence of unplanned returns to the OR after keratoplasty varies significantly by procedure type.
- Graft detachment is a key driver for reoperation, particularly after DALK and DSEK.
- National data on these outcomes can serve as benchmarks for corneal surgical quality assessment.
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